Chiropractic Neck Manipulation and Cervical Artery Dissections / Strokes: The Evidence

Taylor Nichols, MD
2 min readJan 24, 2023

Cervical artery neck dissections are a known though uncommon complication of neck manipulation or rapid rotational force applied to the neck, particularly in an extended position.

Cervical artery dissections occur in an estimated 1:20,000 neck manipulations but there are LOTS of manipulations performed each day .

Yet despite this evidence, chiropractors continue to practice rapid neck manipulation for the “neck cracking” effect.

I have received a lot of push back over the suggestion to never allow a chiropractor to manipulate your neck. So let’s look over the evidence.

From Dr. Josh Farkas at EMCrit

This has been discussed in the the scientific literature since the 1990s, so here’s some of the evidence:

https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000200

https://www.jvascsurg.org/article/0741-5214(91)70095-O/fulltext

A couple quotes from this article: “Although a link between chiropractic and VAD has been clearly established a population at particular risk has not been identified.”

“In particular the vertebral artery is sus- ceptible to injury due to its exposed position as it…

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Taylor Nichols, MD

Humanist. Emergency Medicine and AddictiEmergency + Addiction Medicine | Health policy and advocacy | Health tech and innovation